This week, we're talking about High-Leverage Practice number 20: provide intensive instruction for academics and behavior. And Marla, I'm super excited to have you back for this conversation because this is literally what you do all day, every day, with students who have not been able to be successful in less intensive settings, and so they get to come hang out in your program, and that's where your team provides these things. So, for you, what does this practice look like?

We are a unique setting where basically the students who are not getting those supports in their locals come to us. And that process is a big process in itself of who makes that decision. But ultimately, in our setting, we provide that intense instruction where we're providing those intense supports that those students may not be getting in their local.

And, it looks different for every student, really depending on their disability or what skills they need or what their current skill sets are. So it looks different for everyone. But for us, I think we're a multidisciplinary building. So we don’t just have people like me as a behavior consultant, but we have teacher consultants, we have occupational therapists, we have physical therapists, we have speech therapists, and also visually blind consultants as well. So it's a very big, diverse group. And I think just depending on the students needs and where they're at, that's where we meet as a team and discuss how we're going to do this if that means are we going to provide more intense reinforcement, are we going to provide certain visuals, are we going to have a certain desk that's going to be shaped for them so that way they have access to their peers. Their curriculum as well; how are we modifying the curriculum so that they can learn at their level?

So it's a big mix, Heather. And it's not just like one recipe that we have for every student. It looks different for everyone. But yeah, I think it's really fun. It's really a team effort. And we really just want to ensure that whatever recipe, essentially, that we're going to give, that we're going to come up with, it's going to best fit the student in that moment of whoever we're serving.

Yeah, I love this analogy of a recipe. Because there are so many different ingredients that come and go, and they all have their different role to play. So, for you and your team, how are you figuring out what is even going to need to be considered? I mean, I'm wondering if the sending team is saying, ‘these are our gaps, and this is what we haven't been able to make progress in,’ but then, how does your team figure out, ‘so then here's what we can do. Here's how we can layer in more than their local can.’

You know, and this is even something I myself am still learning, but I feel more confident and have a better understanding of what that looks like now. I think before I had any school experience, I was like, ‘what the what?’ Because for those who are listening that have that in-home experience or have that clinic experience, the closest that I can match to that question that Heather's just asking, what does it look like for locals transferring a student to your setting? How does that work? For us, we can go into a home or a clinic, we assess the client, and we're seeing, ‘okay, what skills are they needing at this time, what barriers are in their way, what skill sets do they have? And then how do we work around that?’

And it's really you as a BCBA trying to figure that out with a parent. If you can also involve your client in that process, even better. And for schools, it's a whole different ballgame. And Heather, I know you have more of that education background, but I think all of it really starts with that IEP, right? When you're going to meet the student, you're going to meet with their teachers, you're going to meet essentially, with the IEP specifically, what we call our academic achievement level. We really look at that, we really think that's the meat and the potatoes of it all. Of like, okay, this is what they're thriving, this is what they're doing, this is what they're exhibiting. And these are some of the issues that we're having right now. Perhaps they were not able to meet this goal. So we look at that and then, as well as taking into account what parents are saying, what teachers are saying, you know, you kind of gather all of that and determine, okay, what goals do we need to continue to work on? What goals are we going to modify? And I think because they are coming to a different setting, like us, our team's going to propose something else too. And sometimes just the change in itself could be a good thing.

I mean, it's a very complex discussion. I wish I could say it's an easy, like, ‘okay, we just do this.’ But I really do think we should, as best practice ethically, that we have to really individualize the programming for that student so that way they can get the best support that they need, that way, they can be successful. So I think we look at the data as well. Like, how were you tracking this school? How is that looking? And then, as always, we may have to modify it, we may have to continue it, or we may have to discontinue it. But I really think it starts there, at an IEP.

Sometimes, if we have the chance to go out into the locals and observe the students as well and see how they're doing there, and ask questions like, ‘Oh, are these the visuals that they need?’ We also look at their sub-aids and services. Like, okay, this is something that they need. The way I view that is not like a nice-to-have. This is what they need in this setting. So, if a student comes with a behavior intervention plan, it's not like, ‘oh, it's nice-to-have, like, they might need this plan.’ No, this student is exhibiting this. We need to have this plan in place. So, not to get very technical with IEPs, but I think that would be the first thing we look at if we do have a student who's going to come over.

Sure. And I think you're also hinting at how you and your team are making those professional judgments to say this individual needs more. And I think the way you're talking about it is, yes, a local has identified that this kid has more needs than what we're able to support at this moment. And so your team can then take that lead and say, ‘Okay, let's figure out what we can do.’

But you're also talking about ramping up different supports or changing out different services or figuring out when that's working, and you're fading back, right? So how does your team show up with, like, quantifiable proof, that like you just said, this is a need. It's not a nice-to-have; it's a need-to-have. So professionally, how does your team stand on, yeah, this level of intensity is needed, and here's how we're going to do it and how we're going to track it and see if it works or not. But, like, how do you back that level of intensity?

Yes. I think, as you're asking this, I really do just hear my other team members just kind of chiming in. Like I said before and even in other podcasts we've had before, like, it really takes a village. And I think, how do we look at that intensity level? And I think a lot of it just goes based on the data. Okay, how was this looking? And then just kind of determining from there that, okay, this is something that they do need to have.

For example, I'm thinking of a student being referred, maybe not so much for medical reasons, but more for their behavior. And perhaps they're coming in with, like, ‘okay, they need to have a plan,’ or it's saying that they have an intervention plan. Okay, well, then one of the things that I will ask as a behavior consultant, I will ask, ‘okay, send me all the data that you have on this student and their behavior that's right now becoming a barrier in their access to their learning environment.’ And so I will look at that to see if this behavior is intense. Because not to go off the question that you're asking, but because the setting that we're in, like, for those who know about MTSS, we're essentially that tier-three building, right? So, like, it seems like they've exhausted all tier-one, tier-two support, right? And even though those things should always be given at all times, but now there's just a certain number of students who really require that intense support. And that's where that intervention comes in.

And that's where I currently feel like I'm using most of my experience, time, and knowledge as a BCBA. And if I were to get a student who has that, part of me was like, okay, when they say intense in a local, but this is a tier-three building. Is this really intense? And you have to assume, yes, this was intense for a local. But for us, if this is something that's already on their IEP, we have to take it. But sometimes we may just have to, like, ‘okay, let's see how the student does with just a change in the environment to see if these behaviors continue to happen.’ Now, if those behaviors continue to happen and we have our data now that we're also collecting, and then the locals are taking them, we can say, okay, now the student probably just needs a more intensive plan, or we really have to modify this plan now because we're seeing this. And again, it's very different.

We've also seen students who come in with a plan, and then sometimes it's like they're not even showing intense behavior, or if they are exhibiting intense behavior, it's like, what the what? Like, this is nothing really. This is, like, manageable. It's pretty redirectable. And I think if we just intensify our basic classroom management skills. I think the student might be solid or have just more visuals, like those things. 

I'm kind of laughing and smiling as I'm saying this because we've had those situations happen, but I'm just kind of speaking more like, I’m wearing the hat as a BCBA. When you're asking me about intensity and things like that, perhaps at a behavioral level, those are some ways where I can say, okay, this is where they need it, or, like, it's just a nice-to-have. And if it's more nice-to-have, what other supports are we going to be giving in place? That way, we can say they really need to have this plan. Does that make sense?

Oh, absolutely. And I think before we wrap up our conversation today, I want to give you an opportunity to also speak to, you know, we've talked about the professional judgment from our trades, our fields, our skills, how we're viewing what those needs may or may not be. But I want to make sure that you have some time to talk about that student experience. How are they showing up? What shifts are we noticing in them?

Especially, I think on your side, where it's like you already are the intensive and you're trying to decide how to back that out? And like you were just saying, maybe they just need an intensive plan; they don't actually need an intensive placement, those types of things. Can you speak a little bit to the student side? How are the students showing up in a way that is then kind of giving you and your team that ‘Okay, I think we're ready here.’

It depends, right? The students that we have, and again, I can't really like speak exactly like what a student is thinking or what they're going through. But for example, I think there's a student who we recently just had about a year and a half ago, who started with us, and he's been there, it's going to be two years soon. And we've noticed that even just with a change in placement, we saw a huge decrease in his maladaptive behaviors and those challenges.

And we think that was a positive thing. Like, I think maybe just him having the smaller classroom, more one-on-one support, just having more of that quick, fast attention from a staff member compared to a local setting where he was at. And even then, perhaps he was in a resource room, or I forget what kind of classroom he was in. But that was successful, where he seemed happier. Even parents were reporting, ‘Hey, he's coming back home with fewer injuries.’

Like, to me, I would assume that the student is content. We're not seeing these barriers, we're not seeing these behaviors happening as much as what was being reported before. And not to say I firmly believe that what's happening, but I think sometimes just with a change in setting means, as behavior analysts, when there are changes in environment, that's going to influence behavior. And so that itself was already showing us that he was being successful, and that was great.

However, we also have other situations where it's not always like that, behaviors continue to happen, but then you realize they need to be here. This is where they are able to get that support that they need. And for many different, like occupational therapy, if it's at speech therapy, it's multidisciplinary.

But I would say that's a story that comes to mind, where we do see success with students. And I think, even in our days where it is tough. We're seeing behaviors, we're seeing codes, we're seeing crisis, we know that ultimately we're doing the best that we can, and we know that they need to be there. I think we have a great team, and, of course, the goals that we always want them to go back, but I think that will be the perfect setting where they can get those intense supports and needs right now. Curriculum level, behaviorally, and all those other supports that we have. But, yeah, I think it all just depends on their progress and how they're doing, and kind of go from there.

Yeah. Well, thank you so much. I know you live this all day, every day, so I was excited to let you kind of have this conversation for our listeners. So thank you so much for sharing your expertise with us.

Thank you, Heather, so much. I appreciate it.